From the Kathryn Severyns Dement Sleep Disorders Center, Walla Walla, Washington; and Department of Medicine, University of Washington, Seattle.
J Clin Psychiatry. 2012 Jun;73(6):e20. doi: 10.4088/JCP.11073br3.
Shift work disorder (SWD) occurs when individuals are unable to successfully synchronize their internal clocks with a work schedule that requires them to stay awake when it is dark and sleep when it is light. When assessing for SWD, clinicians should take a thorough sleep history and have the patient maintain a sleep diary. Clinicians should also be aware of conditions that commonly occur in conjunction with this illness, including sleep apnea, restless legs syndrome, depressive and anxiety disorders, and chronic fatigue. The primary goal of treatment for SWD is to reduce the rate of circadian misalignment by fostering better sleep when it is desired and improved alertness and functioning when appropriate. Nonpharmacologic strategies (eg, melatonin and light therapy) should be tried before considering medications to promote sleep and/or alertness.
轮班工作障碍（SWD）发生于个体的内部生物钟无法与要求他们在黑暗时保持清醒、在光照时睡眠的工作时间表成功同步时。在评估 SWD 时，临床医生应详细了解睡眠史并让患者保持睡眠日记。临床医生还应了解常见的并发疾病，包括睡眠呼吸暂停、不安腿综合征、抑郁和焦虑障碍以及慢性疲劳。SWD 的治疗的主要目标是通过在需要时促进更好的睡眠并在适当的时候提高警觉性和功能，来减少昼夜节律失调的发生率。在考虑促进睡眠和/或警觉性的药物之前，应先尝试非药物策略（如褪黑素和光照疗法）。
